US8425532B2 - Method and apparatus for accessing the interior of a hip joint, including the provision and use of a novel telescoping access cannula and a novel telescoping obturator - Google Patents

Abstract

A telescoping access cannula comprising:

• • an outer tube;
  • an inner tube carried by the outer tube, the inner tube being coaxial with the outer tube and longitudinally movable relative to the outer tube; and
  • a rotatable member carried by the outer tube and connected to the inner tube, wherein rotation of the rotatable member causes longitudinal movement of the inner tube relative to the outer tube.

Description

REFERENCE TO PENDING PRIOR PATENT APPLICATIONS

This patent application claims benefit of:

(i) pending prior U.S. Provisional Patent Application Ser. No. 61/200,908, filed Dec. 4, 2008 by James Flom et al. for METHOD AND APPARATUS FOR ACCESSING THE INTERIOR OF A HIP JOINT, INCLUDING THE PROVISION AND USE OF A NOVEL TELESCOPING ACCESS CANNULA; and

(ii) pending prior U.S. Provisional Patent Application Ser. No. 61/269,605, filed Jun. 26, 2009 by James Flom et al. for METHOD AND APPARATUS FOR ACCESSING THE INTERIOR OF A HIP JOINT, INCLUDING THE PROVISION AND USE OF A NOVEL TELESCOPING ACCESS CANNULA.

The two (2) above-identified patent applications are hereby incorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to surgical methods and apparatus in general, and more particularly to surgical methods and apparatus for treating the hip joint.

BACKGROUND OF THE INVENTIONThe Hip Joint in General

The hip joint is a ball-and-socket joint which movably connects the leg to the torso. The hip joint is capable of a wide range of different motions, e.g., flexion and extension, abduction and adduction, medial and lateral rotation, etc. SeeFIGS. 1A,1B,1C and1D.

With the possible exception of the shoulder joint, the hip joint is perhaps the most mobile joint in the body. Significantly, and unlike the shoulder joint, the hip joint carries substantial weight loads during most of the day, in both static (e.g., standing and sitting) and dynamic (e.g., walking and running) conditions.

The hip joint is susceptible to a number of different pathologies. These pathologies can have both congenital and injury-related origins. In some cases, the pathology can be substantial at the outset. In other cases, the pathology may be minor at the outset but, if left untreated, may worsen over time. More particularly, in many cases, an existing pathology may be exacerbated by the dynamic nature of the hip joint and the substantial weight loads imposed on the hip joint.

The pathology may, either initially or thereafter, significantly interfere with patient comfort and lifestyle. In some cases, the pathology can be so severe as to require partial or total hip replacement. A number of procedures have been developed for treating hip pathologies short of partial or total hip replacement, but these procedures are generally limited in scope due to the significant difficulties associated with treating the hip joint.

A better understanding of various hip joint pathologies, and also the current limitations associated with their treatment, can be gained from a more thorough understanding of the anatomy of the hip joint.

Anatomy of the Hip Joint

The hip joint is formed at the junction of the femur and the hip. More particularly, and looking now atFIG. 2, the head of the femur is received in the acetabular cup of the hip, with a plurality of ligaments and other soft tissue serving to hold the bones in articulating condition.

More particularly, and looking now atFIG. 3, the femur is generally characterized by an elongated body terminating, at its top end, in an angled neck which supports a hemispherical head (also sometimes referred to as “the ball”). As seen inFIGS. 3 and 4, a large projection known as the greater trochanter protrudes laterally and posteriorly from the elongated body of the femur adjacent to the neck of the femur. A second, somewhat smaller projection known as the lesser trochanter protrudes medially and posteriorly from the elongated body of the femur adjacent to the neck of the femur. An intertrochanteric crest (FIGS. 3 and 4) extends along the periphery of the femur, between the greater trochanter and the lesser trochanter.

Looking next atFIG. 5, the hip socket is made up of three constituent bones: the ilium, the ischium and the pubis. These three bones cooperate with one another (they typically ossify into a single “hip bone” structure by the age of 25) so as to collectively form the acetabular cup. The acetabular cup receives the hemispherical head (i.e., the ball) of the femur.

Both the head of the femur and the acetabular cup are covered with a layer of articular cartilage which protects the underlying bone and facilitates motion. SeeFIG. 6.

Various ligaments and soft tissue serve to hold the ball of the femur in place within the acetabular cup. More particularly, and looking now atFIGS. 7 and 8, the ligamentum teres extends between the ball of the femur and the base of the acetabular cup. As seen inFIG. 9, a labrum is disposed about the perimeter of the acetabular cup. The labrum serves to increase the depth of the acetabular cup and effectively establishes a suction seal between the ball of the femur and the rim of the acetabular cup, thereby helping to hold the head of the femur in the acetabular cup. In addition to the foregoing, and looking now atFIG. 10, a fibrous capsule extends between the neck of the femur and the rim of the acetabular cup, effectively sealing off the ball-and-socket members of the hip joint from the remainder of the body. The foregoing structures (i.e., the ligamentum teres, the labrum and the fibrous capsule) are encompassed and reinforced by a set of three main ligaments (i.e., the iliofemoral ligament, the ischiofemoral ligament and the pubofemoral ligament) which extend between the femur and the perimeter of the hip socket. See, for example,FIGS. 11 and 12 which show the iliofemoral ligament, withFIG. 11 being an anterior view andFIG. 12 being a posterior view.

Pathologies of the Hip Joint

As noted above, the hip joint is susceptible to a number of different pathologies. These pathologies can have both congenital and injury-related origins.

By way of example but not limitation, one important type of congenital pathology of the hip joint involves impingement between the neck of the femur and the rim of the acetabular cup. In some cases, and looking now atFIG. 13, this impingement can occur due to irregularities in the geometry of the femur. This type of impingement is sometimes referred to as a cam-type femoroacetabular impingement (i.e., a cam-type FAI). In other cases, and looking now atFIG. 14, the impingement can occur due to irregularities in the geometry of the acetabular cup. This latter type of impingement is sometimes referred to as a pincer-type femoroacetabular impingement (i.e., a pincer-type FAI). Impingement can result in a reduced range of motion, substantial pain and, in some cases, significant deterioration of the hip joint.

By way of further example but not limitation, another important type of congenital pathology of the hip joint involves defects in the articular surface of the ball and/or the articular surface of the acetabular cup. Defects of this type sometimes start out fairly small but often increase in size over time, generally due to the dynamic nature of the hip joint and also due to the weight-bearing nature of the hip joint. Articular defects can result in substantial pain, induce and/or exacerbate arthritic conditions and, in some cases, cause significant deterioration of the hip joint.

By way of further example but not limitation, one important type of injury-related pathology of the hip joint involves trauma to the labrum. More particularly, in many cases, an accident or sports-related injury can result in the labrum being torn away from the rim of the acetabular cup, typically with a tear running through the body of the labrum. SeeFIG. 15. These types of injuries can be very painful for the patient and, if left untreated, can lead to substantial deterioration of the hip joint.

The Current Trend Toward Treating Joint Pathologies Using Minimally-Invasive, and Earlier, Interventions

The current trend in orthopedic surgery is to treat joint pathologies using minimally-invasive techniques. Such minimally-invasive, “keyhole” surgeries generally offer numerous advantages over traditional, “open” surgeries, including reduced trauma to tissue, less pain for the patient, faster recuperation times, etc.

By way of example but not limitation, it is common to re-attach ligaments in the shoulder joint using minimally-invasive, “keyhole” techniques which do not require laying open the capsule of the shoulder joint. By way of further example but not limitation, it is common to repair torn meniscal cartilage in the knee joint, and/or to replace ruptured ACL ligaments in the knee joint, using minimally-invasive techniques.

While such minimally-invasive approaches can require additional training on the part of the surgeon, such procedures generally offer substantial advantages for the patient and have now become the standard of care for many shoulder joint and knee joint pathologies.

In addition to the foregoing, in view of the inherent advantages and widespread availability of minimally-invasive approaches for treating pathologies of the shoulder joint and the knee joint, the current trend is to provide such treatment much earlier in the lifecycle of the pathology, so as to address patient pain as soon as possible and so as to minimize any exacerbation of the pathology itself. This is in marked contrast to traditional surgical practices, which have generally dictated postponing surgical procedures as long as possible so as to spare the patient from the substantial trauma generally associated with invasive surgery.

Treatment For Pathologies of the Hip Joint

Unfortunately, minimally-invasive treatments for pathologies of the hip joint have lagged far behind minimally-invasive treatments for pathologies of the shoulder joint and the knee joint. This is generally due to (i) the constrained geometry of the hip joint itself, and (ii) the nature and location of the pathologies which must typically be addressed in the hip joint.

More particularly, the hip joint is generally considered to be a “tight” joint, in the sense that there is relatively little room to maneuver within the confines of the joint itself. This is in marked contrast to the shoulder joint and the knee joint, which are generally considered to be relatively “spacious” joints (at least when compared to the hip joint). As a result, it is relatively difficult for surgeons to perform minimally-invasive procedures on the hip joint.

Furthermore, the pathways for entering the interior of the hip joint (i.e., the pathways which exist between adjacent bones, avoid major vascular structures and delicate neurological tissues, etc.) are generally much more constraining for the hip joint than for the shoulder joint or the knee joint. This limited access further complicates effectively performing minimally-invasive procedures on the hip joint.

In addition to the foregoing, the nature and location of the pathologies of the hip joint also complicate performing minimally-invasive procedures on the hip joint. By way of example but not limitation, consider a typical detachment of the labrum in the hip joint. In this situation, instruments must generally be introduced into the joint space using an angle of approach which is offset from the angle at which the instrument addresses the tissue. This makes drilling into bone, for example, significantly more complicated than where the angle of approach is effectively aligned with the angle at which the instrument addresses the tissue, such as is frequently the case in the shoulder joint. Furthermore, the working space within the hip joint is typically extremely limited, further complicating repairs where the angle of approach is not aligned with the angle at which the instrument addresses the tissue.

As a result of the foregoing, minimally-invasive procedures for the hip joint are still relatively difficult to perform and relatively uncommon in practice. Consequently, patients are typically forced to manage their hip pain for as long as possible, until a resurfacing procedure or a partial or total hip replacement procedure can no longer be avoided. These procedures are generally then performed as a highly-invasive, open procedure, with all of the disadvantages associated with highly-invasive, open procedures.

As a result, there is, in general, a pressing need for improved methods and apparatus for treating pathologies of the hip joint.

Arthroscopic Access to the Interior of the Hip Joint

Successful hip arthroscopy generally requires safe and effective access to the interior of the hip joint. More particularly, successful hip arthroscopy generally requires the creation of a plurality of access portals which extend inwardly from the surface of the skin, down to the interior of the hip joint, extending through the intervening layers of tissue, including skin, fat, muscle and capsule tissue. These access portals may also continue down to the specific surgical site within the interior of the hip joint. Depending on the specific surgical site which is to be accessed within the interior of the hip joint, different anatomical pathways may be utilized for the access portals. By way of example but not limitation, one anatomical pathway may be used where a torn labrum is to be repaired, and another anatomical pathway may be used where the lesser trochanter must be addressed. And, in most cases, multiple access portals are required, with one access portal being used for visualization (i.e., to introduce an arthroscope into the interior of the hip joint), while other access portals are used for irrigation and to pass surgical instruments to and from the surgical site, etc.

Establishing these access portals typically involves forming an opening from the top surface of the skin down to the interior of the joint, and lining that opening with a tubular liner (sometimes referred to as an “access cannula”). This access cannula holds the incision open and provides a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the access cannula so as to reach the remote surgical site within the joint. Thus the provision and use of access cannulas are generally an important aspect of enabling minimally-invasive, “keyhole” surgery to be performed on the hip joint.

Prior Art Access Cannulas

Access cannulas have traditionally been tubular structures of fixed length. However, this fixed length construction can be problematic for a variety of reasons. For the sake of convenience, these problems can generally be broken down into “static” considerations and “dynamic” considerations.

“Static” Considerations

First, it will be appreciated that patients have anatomies of different sizes, so that an access cannula of a given length might be too short for one patient and too long for another patient. In this respect it will be appreciated that it is generally necessary for the access cannula to extend the entire distance from the top of the skin down to the interior of the hip joint in order to ensure safe instrument passage. However, it will also be appreciated that it is generally undesirable for the access cannula to extend an excessive distance above the top surface of the skin, since this can create a field of protruding cannula “masts” which can obstruct other surgeon activities, impede access of instruments into the joint space, limit the available working length of the surgical instruments (thereby limiting the ability to treat pathologies of the joint), etc.

Second, the patient's anatomy generally dictates that only certain entry points may be used for the access portals, and various procedures must generally address specific regions of the joint, so that—even when dealing with the anatomy of only a single patient—each access corridor may extend for a different span and thus require the use of an access cannula of a different length.

It will also be appreciated that it is generally undesirable for the distal end of the access cannula to extend an excessive distance into the joint compartment, since this would tend to limit visualization within the joint by the arthroscope and/or limit the range of motion of a surgical instrument within the joint space.

The foregoing considerations would suggest that manufacturers should offer their access cannulas in a range of different lengths. However, such an approach would create substantial inventory issues for manufacturers as well as for healthcare facilities (e.g., hospitals, surgical centers, etc.), all of whom must stock the access cannulas prior to surgery. For this reason, access cannulas are generally manufactured with a fixed length which is generally adequate, but not optimal, for most patients and most procedures.

“Dynamic” Considerations

In addition to the foregoing, it should also be appreciated that, in many situations, the surgeon may need to adjust the position of the distal end of the cannula during the surgical procedure. This may be required in order to facilitate better visualization of the surgical site, and/or to properly direct instruments at the surgical site, etc. However, with an access cannula of fixed length, this generally requires moving the entire cannula relative to the patient's tissue, which can result in the “loss” of the defined pathway from the top of the skin down to the interior of the hip joint, as well as be traumatic for patient tissue and inconvenient for the surgeon.

In addition, tissue can swell during the course of an arthroscopic procedure, particularly since the joint is typically irrigated with fluid during the arthroscopic surgery in order to improve visualization and wash away debris, etc. Accordingly, a fixed length cannula, even if it may happen to be of an appropriate length at the beginning of a procedure, may become too short during the course of the procedure as the intervening tissue absorbs fluid and swells up in size.

The Need for a New and Improved Access Cannula

On account of the foregoing, it will be appreciated that there is a need for a new and improved access cannula which can have its overall length adjusted, either before deployment in the body or after deployment in the body, or both.

SUMMARY OF THE INVENTION

These and other objects of the present invention are addressed by the provision and use of a new and improved access cannula for accessing the interior of a hip joint or other interior body space. The new and improved access cannula utilizes a telescoping construction so that the overall length of the access cannula can be adjusted, either before deployment in the body or after deployment in the body, or both. In accordance with the present invention, this telescoping construction can be achieved in a variety of different ways, each with its own attendant advantages, as will hereinafter be discussed in further detail.

The present invention also comprises the provision and use of a telescoping obturator which may be used in conjunction with the telescoping access cannula of the present invention.

In one form of the invention, there is provided a telescoping access cannula comprising:

an outer tube;

an inner tube carried by the outer tube, the inner tube being coaxial with the outer tube and longitudinally movable relative to the outer tube; and

a rotatable member carried by the outer tube and connected to the inner tube, wherein rotation of the rotatable member causes longitudinal movement of the inner tube relative to the outer tube.

In another form of the invention, there is provided a telescoping access cannula comprising:

an outer tube; and

an inner tube carried by the outer tube, the inner tube being longitudinally movable relative to the outer tube;

wherein movement of the inner tube relative to the outer tube is controlled by movement of a finger relative to a seat.

In another form of the invention, there is provided a telescoping access cannula comprising:

an outer tube; and

an inner tube carried by the outer tube, the inner tube being longitudinally movable relative to the outer tube;

wherein rotational movement of the inner tube relative to the outer tube permits longitudinal motion of at least a portion of the inner tube relative to the outer tube.

In another form of the invention, there is provided a telescoping obturator comprising:

a handle;

a shaft carried by the handle, the shaft being longitudinally movable relative to the handle; and

a locking mechanism for selectively locking the shaft to the handle.

In another form of the invention, there is provided a system comprising a telescoping access cannula and a telescoping obturator disposable within the telescoping access cannula,

the telescoping access cannula comprising:

• • an outer tube;
  • an inner tube carried by the outer tube, the inner tube being coaxial with the outer tube and longitudinally movable relative to the outer tube; and
  • a rotatable member carried by the outer tube and connected to the inner tube, wherein rotation of the rotatable member causes longitudinal movement of the inner tube relative to the outer tube; and

the telescoping obturator comprising:

• • a handle;
  • a shaft carried by the handle, the shaft being longitudinally movable relative to the handle; and
  • a locking mechanism for selectively locking the shaft to the handle.

In another form of the invention, there is provided a system comprising a telescoping access cannula and a telescoping obturator disposable within the telescoping access cannula,

the telescoping access cannula comprising:

• • an outer tube; and
  • an inner tube carried by the outer tube, the inner tube being longitudinally movable relative to the outer tube;
  • wherein movement of the inner tube relative to the outer tube is controlled by movement of a finger relative to a seat; and

the telescoping obturator comprising:

• • a handle;
  • a shaft carried by the handle, the shaft being longitudinally movable relative to the handle; and
  • a locking mechanism for selectively locking the shaft to the handle.

In another form of the invention, there is provided a method for providing an access corridor from a first location located outside the body to a second location located inside the body, the method comprising:

providing a telescoping access cannula having a first overall length and adjustable to a different overall length;

inserting the telescoping access cannula into the body so that the proximal end of the telescoping access cannula is located at the first location and the distal end of the telescoping access cannula is disposed inside the body.

In another form of the invention, there is provided a method for providing an access corridor from a first location located outside the body to a second location located inside the body, the method comprising:

providing a telescoping access cannula having a first overall length and adjustable to a different overall length;

measuring the distance from the first location to the second location;

adjusting the length of the telescoping access cannula from the first overall length to another length which is a function of the distance from the first location to the second location; and

inserting the telescoping access cannula into the body so that the proximal end of the telescoping access cannula is located at the first location and the distal end of the telescoping access cannula is disposed inside the body.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts, and further wherein:

FIGS. 1A-1D are schematic views showing various aspects of hip motion;

FIG. 2 is a schematic view showing the bone structure in the region of the hip joints;

FIG. 3 is a schematic view of the femur;

FIG. 4 is a schematic view of the top end of the femur;

FIG. 5 is a schematic view of the pelvis;

FIGS. 6-12 are schematic views showing the bone and soft tissue structure of the hip joint;

FIG. 13 is a schematic view showing cam-type femoroacetabular impingement (FAI);

FIG. 14 is a schematic view showing pincer-type femoroacetabular impingement (FAI);

FIG. 15 is a schematic view showing a labral tear;

FIGS. 16-25 are schematic views showing a first type of telescoping access cannula formed in accordance with the present invention, as well as a telescoping obturator which may be used in conjunction with the same;

FIGS. 25A-25E are schematic views showing the telescoping access cannula and telescoping obturator ofFIGS. 16-25 being used in a surgical procedure;

FIG. 26 is a schematic view showing a modified form of the first type of telescoping access cannula ofFIGS. 16-25;

FIGS. 27-29 are schematic views showing a second type of telescoping access cannula formed in accordance with the present invention;

FIGS. 30-41 are schematic views showing a third type of telescoping access cannula formed in accordance with the present invention, withFIG. 32 being a sectional view taken along line32-32 ofFIG. 30;

FIGS. 42-46 are schematic views showing a fourth type of telescoping access cannula formed in accordance with the present invention;

FIGS. 47-49 are schematic views showing a fifth type of telescoping access cannula formed in accordance with the present invention;

FIGS. 50-54 are schematic views showing a sixth type of telescoping access cannula formed in accordance with the present invention;

FIGS. 55-58 are schematic views showing a seventh type of telescoping access cannula formed in accordance with the present invention;

FIGS. 59-60 are schematic views showing an eighth type of telescoping access cannula formed in accordance with the present invention;

FIGS. 61-65 are schematic views showing a ninth type of telescoping access cannula formed in accordance with the present invention; and

FIGS. 66-72 show additional telescoping obturator constructions.

FIRST TYPE OF TELESCOPING ACCESS CANNULA

Looking first atFIGS. 16-25, there is shown a telescopingaccess cannula assembly5 formed in accordance with the present invention. Telescopingaccess cannula assembly5 generally comprises atelescoping access cannula10 and atelescoping obturator15.

Telescopingaccess cannula10 generally comprises anouter tube20, aninner tube25 telescopically disposed withinouter tube20, and a tubularrotatable member30 for controlling the relative longitudinal disposition ofinner tube25 relative toouter tube20.Outer tube20,inner tube25 and tubularrotatable member30 together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

Outer tube20 comprises an outer thread35 (partial, full or multiple thread) for stabilizingouter tube20 within tissue, aninner thread37 formed on the interior wall ofouter tube20, aport40 communicating with the interior ofouter tube20, and aproximal flange42 including one ormore keyways43.

Inner tube25 comprises an outer thread45 (partial, full or multiple thread) formed on the outer surface ofinner tube25, and afinger50 projecting laterally outwardly from the outer surface ofinner tube25.

Rotatable member30 comprises ahollow tube53 having a substantiallylongitudinal slot55 formed therein; slot55 forms an angle of less than 90 degrees to the longitudinal axis ofhollow tube53, and preferably forms an angle of less than 45 degrees to the longitudinal axis ofhollow tube53, and is more preferably substantially aligned with the longitudinal axis ofhollow tube53. Preferably a pair ofseals60,65 are mounted to the proximal end ofrotatable member30 and captured in place via ahollow rim cap70.Seals60,65 are of the sort well known in the art for passing instruments therethrough while retarding fluid flow therethrough.Cap70 is assembled ontoproximal flange42 ofouter tube20, but can rotate freely with respect toproximal flange42 ofouter tube20.Cap70 has one ormore keys71 which engagecounterpart keyways72 inseals60,65 androtatable member30 so that all of these components (i.e.,cap70, seals60,65 and rotatable member30) rotate together as a unit.Cap70 includes one ormore keyways73.

Inner tube25 is disposed withinouter tube20 such thatouter thread45 ofinner tube25 engagesinner thread37 ofouter tube20, whereby rotation ofinner tube25 relative toouter tube20 causes longitudinal movement ofinner tube25 relative toouter tube20.Rotatable member30 controls the relative longitudinal disposition ofinner tube25 relative toouter tube20 by providing a means to turninner tube25 relative toouter tube20. More particularly,inner tube25 androtatable member30 are disposed withinouter tube20 such thatfinger50 ofinner tube25 is slidably received withinslot55 ofrotatable member30.Slot55 preferably has closed ends (as shown inFIG. 20) so as to limit movement ofinner tube25 relative torotatable member30, butslot55 can also have an open end if desired. As a result of this construction, when the proximal end ofrotatable member30 is turned (e.g., by turning cap70),rotatable member30 will induce a corresponding rotational movement ofinner tube25 relative toouter tube20, whereby to induce longitudinal movement ofinner tube25 relative toouter tube20. Thus, by turningrotatable cap70 in one direction or the other direction relative toouter tube20,inner tube25 can be projected out of, or retracted into,outer tube20.

It will be appreciated thatouter tube20,inner tube25 and tubularrotatable member30 are all aligned co-axial with one another, so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

Telescopingaccess cannula10 can have an inner diameter of between about 1 mm and about 20 mm, but is preferably between about 4 mm and about 15 mm, and more preferably between about 5 mm and about 10 mm. Telescopingaccess cannula10 can have a working length—that is, the distance between the underside ofproximal flange42 ofouter tube20 to the distal end ofinner tube25—ranging from about 10 mm to about 300 mm, but is preferably between about 30 mm and about 200 mm. Telescopingaccess cannula10 preferably has an adjustable length typically up to approximately 50% of the length of theouter tube20, but can exceed this as well. Stated another way, telescopingaccess cannula10 typically has a working length which can range between (i) the distance between the underside ofproximal flange42 ofouter tube20 and the distal end ofouter tube20, and (ii) approximately 150% of that length, or more.

Outer tube20,inner tube25,rotatable member30 andcap70, as well as selected other components oftelescoping access cannula10, may be constructed of plastic or metal, but are preferably plastic. Plastic materials include, but are not limited to: nylon, polycarbonate, ABS, acrylic, polyethylene, and polypropylene. The plastic components can be rigid, semi-flexible or flexible. Flexibility can enable one or more portions of thetelescoping access cannula10 to flex within the tissue, thereby enabling improved instrument mobility and/or visualization. The cannula components can be machined or plastic injection molded, as appropriate. Theseals60,65 can be constructed out of a rubber (e.g., silicone) or a thermoplastic elastomer.

Obturators are blunt instruments which are typically disposed within the central lumens of access cannulas during deployment, in order to prevent tissue coring during cannula insertion. In accordance with the present invention, atelescoping obturator15 is provided for use withtelescoping access cannula10.

Telescopingobturator15 generally comprises ashaft75 and ahandle80.Handle80 comprises one ormore keys82 for engagingkeyways43 inproximal flange42 ofouter tube20, whereby handle80 of telescopingobturator15 can be used to turnouter tube20 oftelescoping access cannula10 during introduction through tissue. Additionally, handle80 of telescopingobturator15 comprises one ormore keys83 for engagingkeyways73 incap70. As noted above,cap70 is keyed torotatable member30 which in turn engages telescopinginner tube25. Thus, handle80 is keyed toinner tube25 as well. On account of the foregoing, since handle80 keys to both outer tube20 (viakeys82 and keyways43) and to inner tube25 (viakeys83 andkeyways73,cap70 and rotatable member30),outer tube20 cannot rotate relative to theinner tube25 during introduction of the telescoping access cannula through tissue. This prevents changes in the overall length of the telescoping access cannula during insertion through tissue.

Shaft75 of telescopingobturator15 comprises a plurality ofopenings85.Openings85 operate in conjunction with arelease mechanism90 carried onhandle80 which is used to adjust how much ofshaft75 extends out ofhandle80. More particularly,release mechanism90 comprises abutton95 which moves afinger96 against the action of aspring97. By depressingbutton95,finger96 can be disengaged from anopening85 inshaft75, thereby allowingshaft75 to be moved further in or out ofhandle80.

Conversely, releasingbutton95 allowsfinger96 to seat in anopening85 inshaft75, whereby to lockshaft75 in position relative to handle80.

If desired, telescopingobturator15 can be cannulated, such that telescoping obturator15 (and telescoping access cannula10) can be delivered over a guidewire, switching stick and/or other instrument.

In use, and looking now atFIG. 25A, a guidewire G is preferably first passed from the outer surface of the skin O, down through the intervening tissue T, through capsule C and into the interior of the joint J. Then a switching stick S, having length markers M formed thereon, is inserted over guidewire G, so that switching stick S extends from the outer surface of the skin O down through the intervening tissue T to the capsule C. Then guidewire G is preferably removed from the surgical site, leaving switching stick S in place. Using length markers M on switching stick S, the distance from the capsule C to the outer surface of the skin O is measured. This measurement can assist in properly sizing the telescoping access cannula so as to optimize its use with the unique anatomy of the patient.

More particularly, using this measurement of the distance from the outer surface of the skin O down to the capsule C, telescopingaccess cannula10 is set to a desired insertion length, e.g., by turningcap70 so as to adjust the degree to whichinner tube25 extends out ofouter tube20. Then telescopingobturator15 is disposed withintelescoping access cannula10 so that the blunt distal tip ofshaft75 of telescopingobturator15 extends out of the distal end ofinner tube25 oftelescoping access cannula10, and so thatkeys82 and83 seat inkeyways43 and73, respectively. Then telescopingobturator15 is set to a corresponding length, e.g., by depressingbutton95 and adjusting the extent to whichshaft75 extends out ofhandle80.

Next, and looking now atFIGS. 25B and 25C, telescopingobturator15 is used to inserttelescoping access cannula10 into the tissue, e.g., by simultaneously pushing and turninghandle80 so as to turnouter thread35 ofouter tube20 into the tissue. It will be appreciated that as this occurs, the engagement ofkeys82 and83 inkeyways43 and73, respectively, keepouter tube20 andinner tube25 from moving relative to one another. Cannula advancement is preferably continued untilproximal flange42 ofouter tube20 settles against the outer surface of the skin. Then switching stick S andtelescoping obturator15 are removed from telescopingaccess cannula10. SeeFIGS. 25D and 25E.

At this point the overall length of the telescoping access cannula may be further adjusted as desired by turningcap70, whereby to moveinner tube25 relativeouter tube20. This action causes the distal end ofinner tube25 to extend, or retract, relative toouter tube20, while leavingouter tube20 stationary relative to the tissue, whereby to minimize trauma to the tissue. Thereafter, telescopingaccess cannula10 may be used as a corridor for accessing the interior of the hip joint, by passing instrumentation (e.g., arthroscopes, surgical instruments, etc.) through the central lumen of the telescoping access cannula, whereby to reach a remote surgical site within the joint.

Significantly, if it should subsequently be desired to modify the length oftelescoping access cannula10 in situ, during the procedure, this may be safely and conveniently done, by simply rotatingcap70, whereby to adjust the disposition of the distal end ofinner tube25 relative toouter tube20. Again, this occurs without changing the position ofouter tube20 relative to the tissue.

Significantly, the length oftelescoping access cannula10 may be adjusted multiple times during a surgical procedure. For example, the user may desire that the distal end of the telescoping access cannula be retracted, or moved in a proximal direction, but without movingouter tube20. This could, for example, enable improved mobility of an instrument that is subsequently inserted through the cannula. Additionally, this could be performed because the distance from the outer surface of the skin to a location within the joint has changed during the course of the surgical procedure, e.g., due to tissue swelling—in this case, changing the overall length of the telescoping access cannula enables the distal end of the cannula to remain at the same location.

Looking next atFIG. 26, there is shown a related construction fortelescoping access cannula10. More particularly, the telescoping access cannula shown inFIG. 26 is preferably substantially identical to the telescoping access cannula shown inFIGS. 16-22, except that in this form of the invention, thefinger50A is formed onrotatable member30 and thelongitudinal slot55A is formed ininner tube25—finger50A rides inlongitudinal slot55A so as to transmit rotary motion fromrotatable member30 toinner tube25.

SECOND TYPE OF TELESCOPING ACCESS CANNULA

In another form of the invention, a spline connection may be used to transfer rotational motion from a keyed driver (i.e., the rotatable member discussed above) to the telescoping inner tube. More particularly, and looking now atFIGS. 27 and 28, there is shown another noveltelescoping access cannula110 formed in accordance with the present invention. Telescopingaccess cannula110 generally comprises a tubular stationary body120 (i.e., the aforementioned outer tube) for seating in the patient's tissue, a telescopinginner tube125 for adjustable positioning relative tostationary body120, and a tubular keyeddriver130 for turning telescopinginner tube125 relative tostationary body120, whereby to adjustably position telescopinginner tube125 relative tostationary body120. Tubularstationary body120, telescopinginner tube125 and tubular keyeddriver130 together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

More particularly,stationary body120 generally comprises a tube-like structure havingsecurement threads135 formed on its outer surface andtranslation threads140 formed on its inner surface. Although shown on the proximal end ofstationary body120,securement threads135 can be located at the distal or middle portions ofstationary body120, or alternatively along the entire length ofstationary body120. Alternatively,inner tube125 can comprise securement threads (e.g., on its distal end, where it is safely clear of stationary body120). The proximal portion ofstationary body120 preferably comprises aflange145.Flange145 preferably comprises one or more keyways150 (FIG. 28) for selectively receiving the one ormore keys82 of telescopingobturator15, as will hereinafter be discussed in further detail.

Telescopinginner tube125 generally comprises a tube-like structure sized to be slidably received instationary body120 and havingtranslation threads155 formed on its outer surface and at least one, and preferably a plurality of,slots160 formed on its proximal end.Translation threads155 of telescopinginner tube125 engagetranslation threads140 ofstationary body120, such that rotation of telescopinginner tube125 relative tostationary body120 causes longitudinal movement of telescopinginner tube125 relative tostationary body120.Translation threads155 of telescopinginner tube125 can be a portion of a thread, a full thread or a plurality of threads. Astop167 near or at the proximal end of telescopinginner tube125 engages acorresponding stop166 at or near the distal end of thestationary body120 so as to limit the extent of distal movement of the telescopinginner tube125 vis-à-visstationary body120.

Keyed driver130 generally comprises a shorttubular head165 rotatably mounted tostationary body120 and having at least one, and preferably a plurality of,fingers170 extending distally therefrom.Fingers170 of keyeddriver130 engagesslots160 of telescopinginner tube125, such that rotational motion imparted to keyeddriver130 can be transferred to telescopinginner tube125 viafingers170 andslots160. Thefingers170 andslots160 thus function as a spline-type mechanism.

It will be appreciated that tubularstationary body120, telescopinginner tube125 and tubular keyeddriver130 are all aligned co-axial with one another, so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

One or more instrument-passingseals175 are preferably disposed intubular head165. Ahollow rim cap176captures seals175 totubular head165, and one or more keyways177 (FIG. 27) are formed incap176 for selectively receivingkeys83 of telescopingobturator15, as will hereinafter be discussed in further detail.Cap176 is rotatable relative to flange145 ofstationary body120, but fixed relative tokeyed driver130, such that rotation ofcap176 will turn keyeddriver130 relative tostationary body120.

Stationary body120, telescopinginner tube125, keyeddriver130 andcap176 are assembled together in the manner shown so as to together constitute the completetelescoping access cannula110. It will be appreciated that, on account of the foregoing construction, rotational motion imparted to cap176 will be transferred to keyeddriver130, and thereafter to telescopinginner tube125 viafingers170 andslots160, such that the longitudinal position of telescopinginner tube125 can be adjusted vis-à-visstationary body120 simply by rotatingcap176.

In one embodiment, telescopingobturator15 can be connected tostationary body120 and cap176 (e.g., withkeys82 of telescopingobturator15 received inkeyways150 ofstationary body120 and withkeys83 of telescopingobturator15 received inkeyways177 of cap176) so that as telescopingaccess cannula110 is twisted and turned by telescopingobturator15 during introduction through tissue, telescopinginner tube125 andstationary body120 do not rotate relative to each other and the overall length of the telescoping access cannula remains constant.

In use,cap176 is first rotated so as to position telescopinginner tube125 in the desired longitudinal position relative tostationary body120, and then telescopingobturator15 is inserted withintelescoping access cannula110 so that the distal end of telescopingobturator15 extends out the distal end oftelescoping access cannula10, and so that the one ormore keys82 of telescopingobturator15 engage the one ormore keyways150 ofstationary body120 and so that the one ormore keys83 of telescopingobturator15 engage the one ormore keyways177 ofcap176. Then telescopingobturator15 is used to advancetelescoping access cannula110 through the anatomy (e.g., over a switching stick) until the distal end of the telescoping cannula is disposed at the joint andflange145 ofstationary body120 lies against the outer surface of the skin. In practice, the user may chose to initially position the distal end of the telescoping access cannula just adjacent to the joint, or just within the joint; the user may also chose to position theflange145 ofstationary body120 somewhat offset from the top surface of the skin. As this is done,telescoping obturator15 may be used to turntelescoping access cannula110 viakeys82 andkeyways150, andkeys83 andkeyways177, so thatsecurement threads135 ofstationary body120 are turned into the tissue. If desired, and as noted above, this cannula deployment may be conducted over a guidewire, switching stick and/or other instrumentation. Thereafter, telescopingobturator15 may be removed, and then keyeddriver130 turned viacap176 as desired so as to adjust the position of telescopinginner tube125 relative tostationary body120, whereby to set the position of the distal end of telescopinginner tube125 relative tostationary body120 and hence relative to the anatomy. The telescoping access cannula may then be used as a corridor for accessing the interior of the hip joint, by passing instrumentation (e.g., arthroscopes, surgical instruments, etc.) through the central lumen of the telescoping access cannula whereby to reach a remote site within the joint.

Significantly, due to the construction of the telescoping access cannula, the overall length of the telescoping access cannula may be adjusted either before deployment in the body or after deployment in the body, or both.

Looking next atFIG. 29, there is shown a related construction fortelescoping access cannula110. More particularly, the telescoping access cannula shown inFIG. 29 is preferably substantially identical to the telescoping access cannula shown inFIGS. 27 and 28, except that in this form of the invention, theslots160A are formed on keyeddriver130 and thefingers170A are formed on telescopinginner tube125. As mentioned above, a plurality of fingers and slots is preferable, although just one finger and just one slot may be provided if desired.

THIRD TYPE OF TELESCOPING ACCESS CANNULA

In another form of the invention, a screw thread may be used to transfer rotational motion from a rotatable member to the telescoping inner tube.

More particularly, and looking now atFIGS. 30-35, there is shown a noveltelescoping access cannula200 formed in accordance with the present invention. Telescopingaccess cannula200 generally comprises a tubularstationary body205 for seating in the patient's tissue, a telescopinginner tube210 for adjustable positioning relative tostationary body205, and a tubular threadeddriver215 for turning telescopinginner tube210 relative tostationary body205, whereby to adjustably position telescopinginner tube210 relative tostationary body205. Tubularstationary body205, telescopinginner tube210 and tubular threadeddriver215 together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

More particularly,stationary body205 generally comprises a tube-like structure. The proximal portion ofstationary body205 preferably comprises aflange220 havingkeyways222 for receiving theaforementioned keys82 of telescopingobturator15. If desired, securement threads (not shown) may be disposed on the outer surface ofstationary body205. The inner lumen ofstationary body205 is preferably formed with a hexagonal cross-section.

Telescopinginner tube210 generally comprises a tube-like structure sized to be slidably received instationary body205 and havingtranslation threads225 formed on its inner surface. At least a portion of telescopinginner tube210 is formed with at least one flat for alignment with at least one flat ofstationary body205, so that telescopinginner tube210 cannot rotate relative tostationary body205. This is important if rotation of threadeddriver215 is to impart longitudinal movement to telescopinginner tube210. In one embodiment, the outer surface of telescopinginner tube210 comprises six flats (e.g., a hexagonal geometry) and the inner surface ofstationary body205 comprises six corresponding flats (e.g., a corresponding hexagonal geometry).FIG. 32 is a cross-section of the telescopinginner tube210 andstationary body205 with corresponding hexagonal geometry. Although a hexagonal cross-section is depicted forstationary body205 and telescopinginner tube210, any feature which prevents rotation betweeninner tube210 withstationary body205 may suffice; for example, a single flat on an otherwise circular geometry, an octagonal cross-section, a key that slides in a slot, etc. may all be utilized to inhibit rotation between the two members.

Threadeddriver215 generally comprises a tube-like structure sized to be slidably received in telescopinginner tube210, and havingtranslation threads230 formed on its outer surface. The proximal portion of threadeddriver215 comprises aflange235 havingkeyways236 for receiving theaforementioned keys83 of telescopingobturator15. Preferably one or more instrument-passing seals are disposed inflange235.Flange235 of threadeddriver215 is rotatably mounted toflange220 ofstationary body205, such that threadeddriver235 can move rotationally, but not longitudinally, relative tostationary body205.Translation threads230 of threadeddriver215 engagetranslation threads225 of telescopinginner tube210, such that rotational motion imparted to threadeddriver215 can be transferred to telescopinginner tube210 viatranslation threads230,225.

Stationary body205, telescopinginner tube210 and threadeddriver215 are assembled together in the manner shown so as to constitute thecomplete access cannula200. It will be appreciated that, on account of the foregoing construction, rotational motion imparted to threadeddriver215 will be transferred to telescopinginner tube210 viatranslation threads230,225, such that the longitudinal position of telescopinginner tube210 can be adjusted vis-à-visstationary body205 by rotating threadeddriver215.

It will be appreciated that tubularstationary body205, telescopinginner tube210 and tubular threadeddriver215 are all aligned co-axial with one another so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

In use, telescopingaccess cannula200 is first adjusted so as to have a desired overall length, e.g., by turning threadeddriver215 so as to adjust the position of the distal end of telescopinginner tube210 relative tostationary body205. Then telescopingaccess cannula200 is disposed in tissue, e.g., by usingtelescoping obturator15 in the manner previously discussed, withkeys82,83 of telescopingobturator15 disposed inkeyways222,236, respectively, oftelescoping access cannula200. Then telescopingobturator15 is removed, and threadeddriver215 is used as desired to further adjust the position of the distal end of telescopinginner tube210 relative tostationary body205, and hence relative to the anatomy. The telescoping access cannula may then be used as a corridor for accessing the interior of the hip joint, by passing instrumentation (e.g., arthroscopes, surgical instruments, etc.) through the central lumen of the telescoping access cannula whereby to reach a remote site within the joint.

Significantly, due to the construction of the telescoping access cannula, the overall length of the telescoping access cannula may be adjusted either before deployment in the body or after deployment in the body, or both.

Looking next atFIG. 36-41, there is shown a related construction fortelescoping access cannula200. More particularly, the telescoping access cannula shown inFIGS. 36-41 is preferably substantially identical to the telescoping access cannula shown inFIGS. 30-35, except that in this form of the invention,threads225A are formed on threadeddriver215 andthreads230A are formed on telescopinginner tube210. In this construction, it is important that telescopinginner tube210 not rotate relative tostationary body205. This may be effected with the pin-and-slot mechanism show inFIG. 37, i.e., apin298 mounted tostationary body205 and riding in aslot299 formed in telescopinginner tube210.

FOURTH TYPE OF TELESCOPING ACCESS CANNULA

FIGS. 42-46 show a two-stagetelescoping access cannula305 which uses another approach for adjusting the overall length of the telescoping access cannula. More particularly, in this construction, there is provided a first, telescopinginner tube325 which comprises atrack310 which has a helical configuration, and a second, stationaryouter tube320 which comprises at least one (and preferably a pair of) diametrically-opposed fingers315 which ride in thehelical track310 so as to provide a telescoping construction. Tubularstationary member320 andtubular telescoping member325 together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

More particularly, in one preferred form of the invention, there is provided astationary member320 which has a generally tubular construction and which hasinternal fingers315 projecting inwardly therefrom, and there is provided atelescoping member325 which has a generally tubular construction and which has thehelical track310 formed therein.Stationary member320 is intended to be set into tissue, and to this end may include outer threads, etc. Telescopingmember325 is intended to be turned relative tostationary member320, such thatfingers315 riding intrack310 will convert rotary motion into longitudinal motion, whereby to movetelescoping member325 relative tostationary member320. In order to turn telescopingmember325 relative tostationary member320,telescoping member325 preferably includes aslot330 in its proximal end which receives afinger335 of aturning tool340. If desired, holes354 can be disposed along the length ofhelical track315 so as to provide a ratchet action through engagement withfingers315 as telescopingmember325 is turned.Holes354 can be openings, slots, etc., or they can be replaced with bumps or any other feature which engage thefingers315.

It will be appreciated that tubularstationary member320 andtubular telescoping member325 are aligned co-axial with one another, so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

Thus it will be seen that with this form of the invention, turningtool340 is first used to set the desired overall length of the telescoping access cannula, thenstationary member320 is set into the tissue, and then turningtool340 is used to further adjust the overall length of the telescoping access cannula while in the tissue. The telescoping access cannula may then be used as a corridor for accessing the interior of the hip joint, by passing instrumentation (e.g., arthroscopes, surgical instruments, etc.) through the central lumen of the telescoping access cannula, whereby to reach a remote site within the joint.

Significantly, due to the construction of the telescoping access cannula, the overall length of the telescoping access cannula may be adjusted either before deployment in the body or after deployment in the body, or both.

In one preferred form of the invention,telescoping member325 is initially fully retracted intostationary member320,stationary member320 is set into the tissue, and then turningtool340 is used to adjust the overall length of the telescoping access cannula.

FIFTH TYPE OF TELESCOPING ACCESS CANNULA

FIGS. 47-49 show a two-stagetelescoping access cannula400 which uses another approach for adjusting the overall length of the telescoping access cannula. More particularly, in this construction, there is provided a tubularstationary member405 and atubular telescoping member410. Tubularstationary member405 andtubular telescoping member410 together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

Stationary member405 is intended to be set into tissue and, to this end, may include outer threads, etc. Telescopingmember410 is intended to be turned relative tostationary member405 so as to adjust the overall length of the telescoping access cannula. To this end,telescoping member410 comprises ashaft415 terminating in aproximal flange420 and having at least one helical through-slot425 formed therein.Shaft415 has at least onelongitudinal slot430 at its distal end.Longitudinal slot430 receives apin435 which projects inwardly from the side wall ofstationary member405. As a result of this construction, whenproximal flange420 of telescopingmember410 is turned, the presence of helical through-slot425 causesshaft415 to lengthen or shorten, according to the direction in whichproximal flange420 is turned.

It will be appreciated that tubularstationary member405 andtubular telescoping member410 are aligned co-axial with one another so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

Thus, in this form of the invention,proximal flange420 is first turned so as to set the desired overall length of the telescoping access cannula, thenstationary member405 is set into the tissue, and thenproximal flange420 is used to further adjust the overall length of the telescoping access cannula. The telescoping access cannula may then be used as a corridor for accessing the interior of the joint, by passing instrumentation (e.g., arthroscopes, surgical instruments, etc.) through the central lumen of the telescoping access cannula, whereby to reach a remote site within the joint.

Significantly, due to the construction of the telescoping access cannula, the overall length of the telescoping access cannula may be adjusted either before deployment in the body or after deployment in the body, or both.

In one preferred form of the invention,telescoping member410 is initially fully retracted intostationary member405,stationary member405 is set into the tissue, and thenproximal flange420 is used to adjust the overall length of the telescoping access cannula.

It should be appreciated that various alternative constructions may be used to prevent rotation betweenstationary member405 andtelescoping member410. Thus, whileFIGS. 47-49 show alongitudinal slot430 receiving apin435, any features which prevent rotation between thestationary member405 and atelescoping member410 will suffice (e.g., flats, hexagonal cross-sections, keyways, etc.)

SIXTH TYPE OF TELESCOPING ACCESS CANNULA

In another form of the invention, a linear ratchet mechanism is used to form the telescoping access cannula.

More particularly, and looking now atFIGS. 50-52, there is shown a noveltelescoping access cannula500 formed in accordance with the present invention.

Telescopingaccess cannula500 generally comprises a tubularstationary body505 for seating in the patient's tissue and a telescopinginner tube510 for adjustable positioning relative tostationary body505. Tubularstationary body505 and telescopinginner tube510 together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

More particularly,stationary body505 generally comprises a tube-like structure. The proximal portion ofstationary body505 preferably comprises aflange515. If desired, securement threads (not shown) may be disposed on the outer surface ofstationary body505. A plurality ofratchet openings520 are formed instationary body505 for interaction with telescopinginner tube510, as will hereinafter be discussed in further detail.

Telescopinginner tube510 generally comprises a tube-like structure sized to be slidably received instationary body505. The proximal end of telescopinginner tube510 terminates in a plurality of diametrically-opposed fingers525. Diametrically-opposedfingers525 are flexible and includepawls530 at their proximal ends for interaction withratchet openings520 ofstationary body505, as will hereinafter be discussed in further detail.

Stationary body505 and telescopinginner tube510 are assembled together in the manner shown so as to together constitute the completetelescoping access cannula500. It will be appreciated that, on account of the foregoing construction, telescopinginner tube510 may be advanced longitudinally withinstationary body505, withpawls530 making a ratcheting engagement withratchet openings520 instationary body505. Thus, the longitudinal position of telescopinginner tube510 may be advanced or retracted vis-à-visstationary body505 via the aforementioned ratchet mechanism.

It will be appreciated that tubularstationary body505 and telescopinginner tube510 are aligned co-axial with one another so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

Various deployment tools may be used to advance or retract telescopinginner tube510 relative tostationary body505. Furthermore, by appropriately configuring these deployment tools to permit diametrically-opposed fingers525 to be drawn together (i.e., so as to withdrawpawls530 fromratchet openings520 into the interior of stationary body505), telescopinginner tube510 may be drawn fully proximally relative tostationary body505.

In use, telescopingaccess cannula500 is preferably first disposed in tissue, and then telescopinginner tube510 is advanced relative tostationary body505, and hence relative to the anatomy, using the ratchet mechanism. Furthermore, by appropriately configuring the aforementioned deployment tools, telescopinginner tube510 may be withdrawn proximally relative tostationary body505. The telescoping access cannula may then be used as a corridor for accessing the interior of the joint space by passing instrumentation (e.g., arthroscopes, surgical instruments, etc.) through the central lumen of the telescoping access cannula, whereby to reach a remote site within the joint.

Significantly, due to the construction of the telescoping access cannula, the overall length of the telescoping access cannula may be adjusted either before deployment in the body or after deployment in the body, or both.

In one preferred form of the invention, alignment means are provided for ensuring proper alignment betweenstationary body505 and telescopinginner tube510. More particularly, in this form of the invention, there is provided analignment slot535 instationary body505 which receives analignment finger540 which is formed on telescopinginner tube510.

If desired, and looking now atFIGS. 53 and 54,stationary body505 can comprisediscrete ratchet openings520A, and telescopinginner tube510 can comprise fingers525A which includepawls530A on their proximal ends, withpawls530A being releasably received inratchet openings520A, whereby to adjust the overall length oftelescoping access cannula500.

SEVENTH TYPE OF TELESCOPING ACCESS CANNULA

FIGS. 55-58 show how a two-stagetelescoping access cannula600 can have its first stage (i.e., an outer tube605) and its second stage (i.e., a telescoping inner tube610) adjustably locked to one another via a “twist/slide/twist” approach.Outer tube605 andinner tube610 together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

More particularly, in this form of the invention, one of the stages (e.g., outer tube605) has atrack615 formed therein, where thetrack615 includes multiple circumferentially-extendingslots620, and the other of the stages (e.g., telescoping inner tube610) has afinger625 which is received intrack615. As a result of this combination, by using an appropriate “twist/slide/twist” action,finger625 can be seated in an appropriate circumferentially-extendingslot620, whereby to adjustably set the overall length oftelescoping access cannula600.

It will be appreciated thatouter tube605 andinner tube610 are aligned co-axial with one another, so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

EIGHTH TYPE OF TELESCOPING ACCESS CANNULA

In another form of the invention, a modular construction is used to form the telescoping access cannula.

More particularly, and looking now atFIGS. 59 and 60, there is shown a noveltelescoping access cannula700. Telescopingaccess cannula700 generally comprises a tubularstationary body715 for seating in the patient's tissue, and a telescopinginner tube720 for adjustable positioning relative tostationary body715. Tubularstationary body715 and telescopinginner tube720 together form a telescoping tubular liner structure which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

More particularly,stationary body715 generally comprises a tube-like structure havingsecurement threads725 formed on its outer surface and translation threads (not shown) formed on its inner surface. The proximal portion ofstationary body715 preferably comprises aflange730.Flange730 preferably comprises one ormore keyways735 for selective engagement in one or more keys in a corresponding telescoping obturator.

Telescopinginner tube720 generally comprises a tube-like structure sized to be slidably received instationary body715 and havingtranslation threads740 formed in its outer surface.Translation threads740 of telescopinginner tube720 engage the aforementioned translation threads (not shown) ofstationary body715, such that rotation of telescopinginner tube720 relative tostationary body715 causes longitudinal movement of telescopinginner tube720 relative tostationary body715. Telescopinginner tube720 preferably includes one ormore keyways745 on its proximal end for selective engagement by one or more keys in a corresponding telescoping obturator.

Stationary body715 and telescopinginner tube720 are assembled together in the manner shown so as to constitute the completetelescoping access cannula700. It will be appreciated that, on account of the foregoing construction, rotational motion imparted to telescopinginner tube720 will cause the longitudinal position of telescopinginner tube720 to be adjusted vis-a-visstationary body715.

It will be appreciated that tubularstationary body715 and telescopinginner tube720 are aligned co-axial with one another, so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

Thus, in this form of the invention, telescopinginner member720 is first turned so as to set the desired overall length of the telescoping access cannula, thenstationary body715 is set into the tissue, and then telescopinginner member720 is further turned as desired so as to further adjust the overall length of the telescoping access cannula. The telescoping access cannula may then be used as a corridor for accessing the interior of the joint space by passing instrumentation (e.g., arthroscopes, surgical instruments, etc.) through the central lumen of the telescoping access cannula, whereby to reach a remote site within the joint.

Significantly, due to the construction of the telescoping access cannula, the overall length of the telescoping access cannula may be adjusted either before deployment in the body or after deployment in the body, or both.

NINTH TYPE OF TELESCOPING ACCESS CANNULA

Looking next atFIGS. 61-65, there is shown another noveltelescoping access cannula800. Telescopingaccess cannula800 generally comprises anouter sleeve805 and aninner sleeve820 which together form a telescoping tubular liner structure having a central lumen which can be used to provide a surgical pathway (or “corridor”) from the top surface of the skin down to the interior of the hip joint, thereby enabling instrumentation (e.g., arthroscopes, surgical instruments, etc.) to be passed through the central lumen of the telescoping access cannula so as to reach a remote surgical site within the joint. In this way, the telescoping access cannula may be used to enable minimally-invasive, “keyhole” surgery to be performed on the hip joint.

More particularly, telescopingaccess cannula800 generally comprises (i) anouter sleeve805 which includes a proximal lip and seal810 and aguide slot815, (ii) aninner sleeve820 which includes adistal lip825 and aguide pin830, and (iii) atension spring835.Inner sleeve820 is telescopically disposed withinouter sleeve805, withguide slot815 andguide pin830 ensuring smooth telescoping action and withtension spring835 yieldably biasingdistal lip825 toward proximal lip andseal810. It will be appreciated that tubularouter sleeve805 and tubularinner sleeve820 are aligned co-axial with one another, so that their respective lumens collectively form a central lumen for the assembled telescoping access cannula.

ADDITIONAL CONSTRUCTIONS

In addition to the foregoing, it is also anticipated that at least a portion of the telescoping access cannula (e.g., an inner tube) may be formed out of an optically-transmissive material, such that the telescoping access cannula may serve as a light conduit for delivering light from an external light source (e.g., a light diode or light box) to the region around the distal end of the telescoping access cannula. Such an approach can be used to improve visualization of structures disposed adjacent to the distal end of the telescoping access cannula in the interior of a joint, and may also allow for the use of smaller endoscopes, which can be highly advantageous since it can facilitate improved joint access. In this embodiment, the inner cannula is preferably formed out of an optically transmissive material such as acrylic or polycarbonate.

Also, in some preferred forms of the invention, the telescoping access cannula may be provided with fixation features (e.g., slots, knobs, etc.) on the proximal end of the telescoping access cannula (e.g., the stationary tube or knob, etc.) for use in securing suture to the telescoping access cannula.

And, in some preferred forms of the invention, the telescoping access cannula may include fixation features for releasably securing instruments to the telescoping access cannula, e.g., a clamp which mounts onto the proximal end of the telescoping access cannula so as to hold an instrument in position relative to the telescoping access cannula. This feature can help reduce the number of “hands” needed during a surgical procedure, by stabilizing an instrument vis-a-vis the telescoping access cannula (which is itself stabilized relative to the patient's tissue).

Furthermore, the telescoping access cannula can include fixation features and/or other aids for supporting and/or guiding percutaneous instruments used in a surgical procedure. By way of example but not limitation, the telescoping access cannula may include a guide mounted to the telescoping access cannula to help target percutaneous devices to specific locations within the body.

Furthermore, as was stated previously, the port on the stationary tube (e.g.,port40 in outer tube20) is in fluid communication with the interior of the stationary tube. As such, fluid can travel through the inner tube, the stationary tube and the port so as to enter and exit the joint space. Tubing can be connected to the port. In one embodiment, fluid can be pumped into the joint via the tubing. In another embodiment, fluid can be evacuated from the joint via theport40. Tubing can be connected to theport40 which can direct fluid flow; alternatively, tubing can be attached to active suction.

Furthermore, the stationary tube can comprise one or more holes which extend completely through the side wall of the tube, so that the interior of the tube is in communication with the region adjacent the exterior surface of the stationary tube. This enables fluid which has collected in the adjacent tissues to drain into the telescoping access cannula and out the cannula's port. The telescoping inner tube can be provided with similar openings if desired.

Furthermore, although the seals are shown in a proximal location in the telescoping access cannula, one or more of the seals can alternatively be located in a more distal location within the telescoping access cannula. For example, the distal seal can be located in the distal region of the stationary tube, while the proximal seal can be located in the proximal end of the stationary tube. Alternatively, the distal seal can be located in the inner tube.

ADDITIONAL TELESCOPING OBTURATOR CONSTRUCTION

FIGS. 66-68 show an additional telescoping obturator construction. More particularly, the telescoping obturator shown inFIGS. 66-68 is substantially the same as thetelescoping obturator15 discussed above, except that handle80 comprisesopenings85A andshaft75 includesfingers96A. In this form of the invention, the disposition ofshaft75 vis-à-vishandle80 is adjusted by (i) movingopenings85A away fromfingers96A, (ii) adjusting the disposition ofshaft75 relative to handle80, and (iii) movingopenings85A towardsfingers96A. In this embodiment, a movablerack comprising openings85A is activated by the pressing ofbutton95A, e.g., actuation ofbutton95A causes the movable rack (carryingopenings85A) to rotate out of alignment withfingers96A, and the release ofbutton95A causes the movable rack (carryingopenings85A) to rotate back into alignment withfingers96A.

FIGS. 69-72 show yet another telescoping obturator construction. More particularly, thetelescoping obturator15A shown inFIGS. 69-72 is substantially the same as thetelescoping obturator15 discussed above, except that it further comprises an adjustment ring R (FIG. 69). The adjustment ring R is coupled to theobturator handle80A but is capable of rotating relative to the handle, i.e., aboutshaft75A. The adjustment ring R haskeys82A which engage thekeyways43 in thetelescoping access cannula10 such that when thetelescoping access cannula10 is mounted ontotelescoping obturator15A,keys82A matingly engage keyways43 (FIG. 71).Telescoping obturator15A further compriseskeys83A which are coupled to handle80A and not to adjustment ring R; thus, when adjustment ring R is rotated abouthandle80A,keys83A do not rotate (FIG. 69). When telescopingaccess cannula10 is mounted ontotelescoping obturator15A,keys83A engagekeyways43 of thetelescoping access cannula10. Thus, when the adjustment ring R is rotated, theouter tube20 rotates, butcap70 does not rotate. This effectively is the same action as rotatingcap70 while keepingouter tube25 stationary; both will change the overall length oftelescoping access cannula10.FIG. 72 illustrates thetelescoping access cannula10 in a lengthened state as compared toFIG. 71.

In operation, thetelescoping obturator15A is adjusted to the desired length; this contrasts to thetelescoping access cannula10 being adjusted in length first as described above. Thetelescoping access cannula10 is then mounted onto thetelescoping obturator15A. Then the adjustment ring R of thetelescoping obturator15A is rotated so as to adjust the length of thetelescoping access cannula10 to the correct length. Specifically, this is achieved by aligning the distal end of thetelescoping access cannula10 to a marker or designated location at the distal end of theshaft75A of thetelescoping obturator15A.

SOME ASPECTS OF THE TELESCOPING ACCESS CANNULA

Thus it will be seen that the present invention provides numerous approaches for adjusting the length of the telescoping access cannula, both in-situ and non in-situ. Furthermore, the present invention provides numerous approaches for effecting a desired surgical task, including but not limited to: (i) new and improved approaches for protecting tissue structures between the surface of the skin and the interior of a joint, and/or (ii) measuring the distance between the surface of the skin and the capsule of the joint, adjusting the length of the telescoping access cannula according to the measured distance, and then inserting the telescoping access cannula into tissue, and/or (iii) adjusting the length of the telescoping access cannula in-situ, and/or (iv) adjusting the position of the distal end of the telescoping access cannula in-situ, without moving the proximal end of the telescoping access cannula, etc.

USE OF THE TELESCOPING ACCESS CANNULA FOR OTHER APPLICATIONS

It should be appreciated that the novel telescoping access cannula of the present invention may be used for accessing joints other than the hip joint (e.g., the telescoping access cannula may be used to access the shoulder joint), and/or for accessing other interior body spaces (e.g., the abdominal cavity).

MODIFICATIONS OF THE PREFERRED EMBODIMENTS

It should be understood that many additional changes in the details, materials, steps and arrangements of parts, which have been herein described and illustrated in order to explain the nature of the present invention, may be made by those skilled in the art while still remaining within the principles and scope of the invention.

Claims (23)

What is claimed is:

1. A method for providing an access corridor from a first location located outside the body of a patient to a second location located inside the body of a patient, the method comprising:

providing a telescoping access cannula, the telescoping access cannula comprising:

an outer tube having a proximal end, a distal end, and a lumen extending therebetween;

an inner tube having a proximal end, a distal end, and a lumen extending therebetween, the inner tube being coaxially mounted to the interior of the outer tube by a screw thread so as to be longitudinally movable relative to the outer tube, with the proximal end of the inner tube being disposed within the interior of the outer tube; and

a tubular rotatable member having a proximal end, a distal end, and a lumen extending therebetween, the tubular rotatable member being coaxially mounted to the interior of the outer tube such that the tubular rotatable member is rotatable relative to the outer tube but is prevented from longitudinal movement relative to the outer tube, and the tubular rotatable member being connected to the inner tube by a finger-and-slot connection, such that rotation of the tubular rotatable member relative to the outer tube causes corresponding rotation of the inner tube relative to the outer tube and results in longitudinal movement of the inner tube relative to the outer tube;

inserting the telescoping access cannula into the body of the patient so that the proximal end of the outer tube is located at the first location and the distal end of the outer tube is disposed inside the body.

2. A method according toclaim 1 wherein the tubular rotatable member comprises a substantially longitudinally-extending slot, and further wherein the inner tube comprises a finger movably disposed within the substantially longitudinally-extending slot.

3. A method according toclaim 2 wherein the finger extends laterally.

4. A method according toclaim 2 wherein the outer surface of the tubular rotatable member and the outer surface of the inner tube are not longitudinally aligned with one another.

5. A method according toclaim 1 wherein, prior to inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube relative to the outer tube.

6. A method according toclaim 5 wherein, prior to inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube proximally relative to the outer tube.

7. A method according toclaim 5 wherein, prior to inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube distally relative to the outer tube.

8. A method according toclaim 1 wherein, after inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube relative to the outer tube.

9. A method according toclaim 8 wherein, after inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube proximally relative to the outer tube.

10. A method according toclaim 8 wherein, after inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube distally relative to the outer tube.

11. A method according toclaim 1 wherein, prior to inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube relative to the outer tube, and further wherein, after inserting the telescoping access cannula into the body of the patient, the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube relative to the outer tube.

12. A method according toclaim 11 wherein, after inserting the telescoping access cannula into the body of the patient, as the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube relative to the outer tube, the proximal end of the cannula remains substantially fixed in position relative to the body of the patient and the distal end of the cannula moves in position relative to the body of the patient.

13. A method according toclaim 1 wherein a telescoping obturator is inserted into the telescoping access cannula before the telescoping access cannula is inserted into the body of the patient.

14. A method according toclaim 13 wherein the telescoping obturator comprises:

a handle;

a shaft carried by the handle, the shaft being longitudinally movable relative to the handle; and

a locking mechanism for selectively locking the shaft to the handle.

15. A method according toclaim 14 wherein the locking mechanism comprises a first element formed on the shaft, and a second element formed on the handle.

16. A method according toclaim 15 wherein at least one of the first and second elements is movable into and out of locking engagement with the other of the first and second elements.

17. A method according toclaim 16 wherein at least one of the first and second elements is movable into and out of locking engagement with the other of the first and second elements via linear motion.

18. A method according toclaim 16 wherein at least one of the first and second elements is movable into and out of locking engagement with the other of the first and second elements via rotational motion.

19. A method according toclaim 15 wherein the first element comprises an opening formed in the shaft, and the second element comprises a finger formed on the handle.

20. A method according toclaim 13 wherein the telescoping obturator has a first shaft length and is adjustable to a second shaft length, and further wherein the telescoping obturator is adjusted so as to have a shaft length which is sufficient to protrude from the telescoping access cannula when the telescoping obturator is positioned in the telescoping access cannula.

21. A method according toclaim 20 wherein the shaft length of the telescoping obturator is adjusted prior to insertion of the telescoping obturator into the telescoping access cannula.

22. A method according toclaim 20 wherein the shaft length of the telescoping obturator is adjusted after insertion of the telescoping obturator into the telescoping access cannula.

23. A method according toclaim 8 wherein, as the tubular rotatable member is rotated relative to the outer tube so as to cause corresponding rotation of the inner tube relative to the outer tube and move the inner tube relative to the outer tube, the outer tube remains substantially fixed in position relative to the body of the patient and the distal end of the inner tube moves in position relative to the body of the patient.

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